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6800 Cannonsburg Rd NE,
Belmont, MI 49306


RELEASE OF LIABILITY, INDEMNITY AGREEMENT AND MEDICAL AUTHORIZATION.  

PLEASE READ CAREFULLY BEFORE SIGNING. THIS IS A RELEASE OF LIABILITY AND WAIVER OF CERTAIN LEGAL RIGHTS.   

In consideration for my child’s/youth’s eligibility to participate in such activities, I, the undersigned parent or legal guardian for a Dirt Dawg participant, release, forever discharge and agree to hold harmless the Grand Rapids Dirt Dawgs and Cannonsburg Ski Area, its representatives, agents, volunteers, directors, officers, successors and assigns from any and all liability, claims, or demands, including without limitation those for personal injury, sickness, or death, property damage and all other expenses of any nature whatsoever, arising out of or relating to my child’s/youth’s participation in any activity for or related to the Grand Rapids Dirt Dawgs. The activities to which this release applies shall include, but are not limited to: weekly practices, related social events, field trips, sporting activities, sporting events, and other activities in which my child/youth may participate in connection with the Grand Rapids Dirt Dawgs. 

I understand this shall be binding upon me, my assignees, subrogors, distributees, heirs, next of kin, executors, personal representatives and administrators and may be pled by The Grand Rapids Dirt Dawgs as a complete bar and defense against any and all claims, demands, or causes of action by or my behalf. Any provision of this which shall prove to be invalid, void or illegal in no way affects, impairs or invalidates any other provision hereof, and such other provisions shall remain in full force and effect. 

I acknowledge the contagious nature of the SARS-CoV-2 virus and voluntarily assume the risk that my child/youth might be exposed to the coronavirus by attending practice and or events put on by The Grand Rapids Dirt Dawgs, and/or participating in any event that such exposure might result in illness, disability, and death. 

I consent to and authorize the taking of photographs and/or videos during my and/or the Minor’s visits to Grand Rapids Dirt Dawgs events. I grant permission to the Grand Rapids Dirt Dawgs to use said photographs and/or videos in advertising, displays, web sites, brochures, other forms of electronic media, illustrations or publications without notifying me.  

I agree to notify both Grand Rapids Dirt Dawg admin AND coaches in the event of any health changes that would restrict my child’s/youth’s participation in any such activities. I understand that the Grand Rapids Dirt Dawgs reserves the right to restrict my child/youth from any activity that the coaches consider not to be within the physical capabilities of my child/ youth. 

I HAVE CAREFULLY READ THE FOREGOING RELEASE OF LIABILITY, INDEMNITY AGREEMENT AND MEDICAL AUTHORIZATION. I UNDERSTAND ITS CONTENTS AND THAT IT IS BINDING DURING THE ENTIRE 2024 SEASON. 

I HAVE THE AUTHORITY TO ENTER INTO IT ON BEHALF OF THE MINOR (IF APPLICABLE). I VOLUNTARILY SIGN IT WITH NO RESERVATIONS AND WITH FULL KNOWLEDGE OF ITS SIGNIFICANCE.


January 1, 2025               

 


First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Signature*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Signature*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Signature*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Signature*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Signature*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Signature*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Signature*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Signature*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Signature*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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